WO2016185468A1 - Combinations of opioids and n-acylethanolamines - Google Patents

Combinations of opioids and n-acylethanolamines Download PDF

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Publication number
WO2016185468A1
WO2016185468A1 PCT/IL2016/050519 IL2016050519W WO2016185468A1 WO 2016185468 A1 WO2016185468 A1 WO 2016185468A1 IL 2016050519 W IL2016050519 W IL 2016050519W WO 2016185468 A1 WO2016185468 A1 WO 2016185468A1
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WO
WIPO (PCT)
Prior art keywords
pharmaceutical composition
salt
opioid
acylethanolamine
oxycodone
Prior art date
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PCT/IL2016/050519
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English (en)
French (fr)
Inventor
Ascher Shmulewitz
Elran HABER
Ephraim Brener
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Therapix Biosciences Ltd.
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Publication date
Priority to JP2017559829A priority Critical patent/JP7244992B2/ja
Priority to PL16796016.0T priority patent/PL3297622T3/pl
Priority to DK16796016.0T priority patent/DK3297622T3/da
Priority to US15/575,655 priority patent/US20180116982A1/en
Application filed by Therapix Biosciences Ltd. filed Critical Therapix Biosciences Ltd.
Priority to CN201680032663.9A priority patent/CN107613966A/zh
Priority to IL305528A priority patent/IL305528A/en
Priority to AU2016263292A priority patent/AU2016263292B2/en
Priority to CN202310348490.3A priority patent/CN116808038A/zh
Priority to EP16796016.0A priority patent/EP3297622B1/en
Priority to CA2985305A priority patent/CA2985305C/en
Publication of WO2016185468A1 publication Critical patent/WO2016185468A1/en
Priority to IL255749A priority patent/IL255749A/en
Priority to US17/105,687 priority patent/US20210177779A1/en
Priority to AU2021204517A priority patent/AU2021204517B2/en
Priority to AU2023251499A priority patent/AU2023251499A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/164—Amides, e.g. hydroxamic acids of a carboxylic acid with an aminoalcohol, e.g. ceramides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • the present invention relates to compositions and methods for potentiating therapeutic effects and/or reducing side-effects of opioids.
  • the present invention provides pharmaceutical compositions comprising opioids and N-acylethanolamines, and methods for their use in a variety of indications amenable to prevention and treatment by opioids, and in preventing and ameliorating opioid-related side effects.
  • Opiates are natural alkaloids found in the resin of the Papaver somniferum (opium poppy), while opioid refers to both opiates and synthetic substances, as well as to opioid peptides. Opioids work by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract (Lesniak et al., Acta. Neurobiol. Exp., 2011, Vol. 71 , pages 129-138). Opioid receptors are a group of inhibitory G protein-coupled receptors, acting on ⁇ -aminobutyric acid GABAergic neurotransmission, with opioids as ligands.
  • a GABAergic agent is a chemical which functions to directly modulate the GABA system in the body or brain.
  • Examples include GABA receptor agonists, GABA receptor antagonists, and GABA reuptake inhibitors.
  • the endogenous opioids are dynorphins, enkephalins, endorphins, endomorphins and nociceptin.
  • the receptors in these organ systems mediate the beneficial effects as well as the psychoactive and the side effects of opioids.
  • ⁇ mi, MOR
  • ⁇ kappa, KOR
  • delta delta, DOR
  • ⁇ epsilon
  • ⁇ iota
  • ⁇ ⁇ (lambda)
  • ⁇ zeta
  • the pharmacodynamic response to an opioid depends upon the receptor to which it binds, its affinity for that receptor, and whether the opioid is an agonist or an antagonist.
  • morphine an opioid agonist analgesic drug
  • ⁇ 2 receptor sedation and spinal analgesia by the K receptor.
  • Each group of opioid receptors elicits a distinct set of neurological responses, with the receptor subtypes (such as ⁇ and ⁇ 2 for example) providing even more specific responses.
  • Unique to each opioid is its distinct binding affinity to the various classes of opioid receptors (e.g. the ⁇ , ⁇ , and ⁇ opioid receptors are activated at different magnitudes according to the specific receptor binding affinities of the opioid).
  • the ⁇ receptors which bind morphine and its derivatives are responsible for analgesia, respiratory and gastrointestinal functions, sedation, neuro-endocrine functions and mediate opiate dependence.
  • the ⁇ receptors are abundant in the central nervous system (CNS) and mediate analgesia, feeding and various hormonal functions.
  • the ⁇ receptors have a wide distribution in the CNS and the peripheral nervous system (PNS); for example, centrally, these receptors are expressed in caudate-putamen, nucleus accumbens, amygdale, neural lobe of the pituitary gland, etc, and peripherally, they are expressed in the sensory neuron posterior root ganglion (DRG), stomach, duodenum, jejunum, oleum, proximal and distal colon (Lesniak and Lipkowski, Acta. Neurobiol. Exp., 2011 , Vol. 71(1), pages 129-138).
  • DPG sensory neuron posterior root ganglion
  • the ⁇ receptors are responsible for functions including analgesia, gastrointestinal functions like food intake, gut motility, water balance, thermoregulation and various neuroendocrine functions (Leander et al., J. Pharmacol. Exp. Ther., 1985, Vol. 234(2), pages 463-469; Goodman and Gilman's The Pharmacological Basis of Therapeutics (12th Edition), 2011, Chapter 18, pages 460-501).
  • US Patent application 2015/0031685 describes substituted heterocyclic acetamides as kappa opioid receptor (KOR) agonists, and claims their use in treating e.g. gastrointestinal dysfunction, ileus and pain.
  • KOR kappa opioid receptor
  • US Patent application 2015/0072971 describes mu opioid receptor (MOR) agonists, and relates to their use in treating depressive symptoms such as depressed mood, loss of pleasure, loss of appetite, sleep disturbance, psychomotor changes, fatigue, and post-partum depression.
  • Opioids generally act on specified opioid receptor, for example morphine acts on ⁇ - opioid receptor, whereas oxycodone mainly binds ⁇ -opioid receptor. However, most of the opioids will bind different opioid receptors with various degree of affinity. Moreover, certain opioids act as opioid-receptor agonists and as opioid-receptor antagonists on different opioid receptors.
  • opioid analgesics such as morphine and codeine
  • ⁇ receptor agonists These opioids have well-known, undesirable and potentially dangerous dependence-forming side effects associated with their activity in CNS.
  • Another widely used opioid is oxycodone, which acts on ⁇ -opioid receptors and appears to be a K2b-opioid agonist.
  • Opioids are effective and widely used medicines for pain management in cancer patients and non-cancer patients.
  • the analgesic (pain-killer) effects of opioids are due to decreased perception of pain, decreased reaction to pain, and/or increased pain tolerance.
  • N-acylethanolamines are lipid-derived signaling molecules. They are formed when one of several types of acyl group is linked to the nitrogen atom of ethanolamine.
  • N-acylethanolamines examples include anandamide (the amide of arachidonic acid (20:4 co-6) and ethanolamine), N-Palmitoylethanolamine (the amide of palmitic acid (16:0) and ethanolamine), N-Oleoylethanolamine (the amide of oleic acid (18:1) and ethanolamine), N- Stearoylethanolamine (the amide of stearic acid (18:0) and ethanolamine) and N- Docosahexaenoylethanolamine (the amide of docosahexaenoic acid (22:6) and ethanolamine).
  • anandamide the amide of arachidonic acid (20:4 co-6) and ethanolamine
  • N-Palmitoylethanolamine the amide of palmitic acid (16:0) and ethanolamine
  • N-Oleoylethanolamine the amide of oleic acid (18:1 and ethanolamine
  • N- Stearoylethanolamine the amide of stearic acid
  • Palmitoylethanolamide (PEA, also known as N-(2-hydroxyethyl)hexadecanamide; Hydroxyethylpalmitamide; palmidrol; N-palmitoylethanolamine; and palmitylethanolamide) is an endogenous fatty acid amide, belonging to the class of nuclear factor agonists.
  • PEA has been demonstrated to bind to a receptor in the cell nucleus (a nuclear receptor) and exerts a variety of biological functions related to chronic pain and inflammation. Studies have shown that PEA interacts with distinct non-CBl/CB2 receptors, suggesting that PEA utilizes a unique "parallel" endoopioid signaling system.
  • PEA production and inactivation can occur independently of AEA and 2-AG production and inactivation.
  • Much of the biological effects of PEA on cells can be attributed to its affinity to PPAR (particularly PPAR-ot and PPAR- ⁇ ).
  • PEA was shown to have an affinity to opioid-like G-coupled receptors GPR55 and GPR119 as well as the transient receptor potential vanilloid type 1 receptor (TRPV1).
  • TRPV1 transient receptor potential vanilloid type 1 receptor
  • PEA has been shown to have anti- inflammatory, anti-nociceptive, neuro-protective, and anti-convulsant properties.
  • PEA opiates and antiepileptic drugs used for neuropathic pain
  • Desio and coworkers conducted an open study in patients suffering from chronic pain and unresponsive to a variety of analgesics. Patients were daily treated with 5 mg oxycodone for 5 days, followed by 10 mg oxycodone for 25 days, in combination (via separate administrations) with 1200 mg PEA.
  • the present invention provides pharmaceutical compositions comprising beneficial combinations of opioids and N-acylethanolamines. These combinations are defined, in part, by specific molar ratios between the respective active agents and/or by their dosages, and may be employed in a variety of methods.
  • the present invention provides methods for preventing and/or treating a variety of conditions responsive to opioid treatment, such as pain. Further, the present invention provides methods for preventing and/or treating conditions or side-effects associated with opioid uptake, such as irritation or confusion.
  • the methods provided herein potentiate the therapeutic effect of prescribed opioids, which may be clinically translated to a more beneficial therapeutic result or to the use of lower dosages of opioids to obtain a predetermined therapeutic result.
  • the methods provided herein further advantageously eliminate or substantially minimize adverse side-effects commonly associated with opioid uptake in opioid -prescribed patients.
  • the therapeutic window (or pharmaceutical window) of the opioid i.e. the range of opioid dosages which can be prescribed and/or treat conditions effectively without having toxic effects, is expended by the combinations provided herein.
  • compositions and methods provided herein also has great benefits over other compositions and methods utilizing opioids and N-acylethanolamines administered separately.
  • the compositions and methods provided herein eliminate the risks involved in consuming opioids alone, such as irritation, confusion, and formation of opioid dependence and addiction, as exemplified herein.
  • patients treated with opioids alone tend to develop tolerance to the drug, which leads to increasing dosage of the drug being needed for exerting the analgesic effect and to subsequent withdrawal symptoms.
  • opioid drugs are given by prescription, but once prescribed and if they are given orally or transdermally, they are self- administered (ex.
  • the present invention is based, in part, on the surprising findings that combinations of opioids and N-acylethanolamines were able to prevent or ameliorate a variety of side-effects associated with intake of opioids in an in-vivo model, and that these combinations were further able to increase the effect of opioids as analgesic agents. Without being bound to any theory or mechanism, it is hypothesized that administration of opioids in mixture with N- acylethanolamines increases the potency of opioids while decreasing their related side-effects, a phenomenon previously labeled "entourage effect".
  • the present invention provides, in one aspect, a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid or the salt thereof and the N-acylethanolamine or the salt thereof is between about 1 :1 to about 1 : 100.
  • the molar ratio is between about 1 :2 to about 1 :80.
  • the molar ratio is between about 1 :2.5 to about 1 :5.
  • the pharmaceutical composition described above comprises about 1-100 mg opioid or a salt thereof.
  • the pharmaceutical composition described above comprises about 20 mg, about 35 mg, about 55 mg, about 70 mg or about 90 mg opioid or a salt thereof
  • the at least one opioid is selected from oxycodone, morphine, codeine, fentanyl, tramadol, hydrocodone, meperidine, hydromorphone, methadone, naloxone, salts thereof and any combination thereof. Each possibility represents a separate embodiment of the invention.
  • the at least one opioid is oxycodone or a salt thereof.
  • the pharmaceutical composition described above comprises about 200-1800 mg N-acylethanolamine or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises about 250 mg, about 500 mg, about 750 mg, about 1000 mg or about 1500 mg N-acylethanolamine or a salt thereof.
  • the N-acylethanolamine is selected from the group consisting of N- palmitoylethanolamine (PEA), Me-palmitoylethanolamide (Me-PEA), palmitoylcyclohexamide, palmitoylbutylamide, palmitoylisopropylamide, oleoylethanolamine (OEA), palmitoylisopropylamide (PIA), salts thereof and any combination thereof.
  • PDA N- palmitoylethanolamine
  • the N- acylethanolamine is PEA or a salt thereof.
  • the mixture comprises oxycodone or a salt thereof and PEA or a salt thereof.
  • the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is between about 1 :2.5 to about 1 :5.
  • the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is about 1 :2.5.
  • the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is about 1 :5.
  • the mixture comprises about 1-100 mg oxycodone or a salt thereof or about 200-1800 mg PEA or a salt thereof.
  • the mixture comprises about 20 mg, about 35 mg, about 55 mg, about 70 mg or about 90 mg oxycodone or a salt thereof or about 250 mg, about 500 mg, about 750 mg, about 1000 mg or about 1500 mg PEA or a salt thereof. In certain embodiments, the mixture comprises about 1-100 mg oxycodone or a salt thereof and about 200-1800 mg PEA or a salt thereof. In certain embodiments, the mixture comprises about 20 mg, about 35 mg, about 55 mg, about 70 mg or about 90 mg oxycodone or a salt thereof and about 250 mg, about 500 mg, about 750 mg, about 1000 mg or about 1500 mg PEA or a salt thereof. Each possibility represents a separate embodiment of the invention.
  • the pharmaceutical composition described above is formulated for systemic administration. In certain embodiments, the pharmaceutical composition described above is formulated for oral, oral mucosal, nasal, sublingual, topical, transdermal, rectal, parenteral, intravenous, intramuscular, subcutaneous, intrathecal, inhalational or vaginal administration. In certain embodiments, the pharmaceutical composition described above is formulated for oral, oral mucosal, nasal, or sublingual administration. Each possibility represents a separate embodiment of the invention.
  • the present invention further provides, in another aspect, a dosage unit comprising or consisting of any one of the pharmaceutical compositions described above.
  • the present invention further provides, in another aspect, a pharmaceutical composition described above, for use in a method for preventing or treating a condition amenable to prevention or treatment by at least one opioid.
  • the pharmaceutical composition described above is for use in a method for preventing or treating pain.
  • the pain is an acute pain, chronic pain or neuropathic pain.
  • the present invention further provides, in another aspect, a pharmaceutical composition described above, for use in a method for preventing or treating at least one side- effect associated with intake of an opioid.
  • the side-effect is irritation. In certain embodiments, the side- effect is confusion, uncontrolled movement and/or disorientation. Each possibility represents a separate embodiment of the invention. In certain embodiments, the side-effect is confusion.
  • condition is amenable to prevention or treatment by oxycodone or a salt thereof, or wherein the side-effect is associated with intake of oxycodone or a salt thereof.
  • the therapeutic potency of the pharmaceutical composition is increased compared to the therapeutic potency of the same pharmaceutical composition without the N-acylethanolamine.
  • the required therapeutic dosage of the opioid in the pharmaceutical composition is decreased compared to the required therapeutic dosage of the opioid of the same pharmaceutical composition without the N- acylethanolamine.
  • at least one of the side-effects of intake of at least one opioid is ameliorated compared to the same side-effect of intake of the same opioid of the same pharmaceutical composition without the N-acylethanolamine.
  • the therapeutic window of the opioid is expended compared to the therapeutic window of the opioid of the same pharmaceutical composition without the N-acylethanolamine.
  • the therapeutic effect of the pharmaceutical composition decreases slower than the therapeutic effect of the same pharmaceutical composition without the N- acylethanolamine.
  • the present invention further provides, in another aspect, a method for preventing or treating a condition amenable to prevention or treatment by at least one opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid and the N-acylethanolamine is between about 1 :1 to about 1 : 100, thereby preventing or treating the condition.
  • the method described above is for preventing or treating pain in a human subject in need thereof.
  • the present invention further provides, in another aspect, a method for preventing or treating at least one side-effect associated with intake of opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid and the N-acylethanolamine is between about 1 :1 to about 1 :100, thereby preventing or treating the at least one side-effect.
  • the administration step is repeated.
  • Figures 1A and IB are bar graphs illustrating different group averages of body weight gain during the study.
  • Figure 2 is a bar graph illustrating different group averages of animal velocity during evaluation in an open field test.
  • Figure 3 is a bar graph illustrating different group averages of total time spent in the center of an arena during evaluation in an open field test.
  • Figures 4A and 4B are bar graphs illustrating different group averages of latency to respond in a tail pinch test.
  • the present invention provides pharmaceutical combinations comprising at least one opioid and at least one N-acylethanolamine.
  • the present invention further provides methods for the use of these combinations in treating diseases or conditions that are amenable to treatment with opioids, and in preventing opioid-related side-effects.
  • the compositions of the invention can be used to treat pain.
  • the compositions of the invention can also be used to induce and maintain anesthesia, and as an analgesic for pain of various etiologies.
  • opioids Besides pain, conditions such as cough, diarrhea, anxiety, and shortness of breath are also routinely treated with opioids.
  • Opioid therapy is frequently accompanied by opioid-related side effects, which include, but are not limited to, addiction, which involves a compulsive use of a drug, constipation, drowsiness, nausea and vomiting, diarrhea, muscle and bone pain, insomnia, anxiety, cold flashes with goose bumps ("cold turkey"), involuntary leg movements and irritability.
  • addiction which involves a compulsive use of a drug, constipation, drowsiness, nausea and vomiting, diarrhea, muscle and bone pain, insomnia, anxiety, cold flashes with goose bumps ("cold turkey”), involuntary leg movements and irritability.
  • goose bumps goose bumps
  • the pharmaceutical compositions of the invention provide an improved medicament: exhibiting an increased opioid therapeutic activity, minimizing administered opioid dosages, prolonging opioid therapeutic window and reducing the risk of developing opioid-related side-effects.
  • the present invention discloses that N-acylethanolamine compounds exhibit an opioid-sparing effect.
  • opioid-sparing refers to the enablement of the use of low dosages of opioids in instances wherein a mid- or high- dosages of opioids are typically required.
  • the opioid and N-acylethanolamine compounds according to the present invention include pharmaceutically acceptable forms thereof, including isomers such as diastereomers and enantiomers, salts, solvates, and polymorphs, as well as racemic mixtures.
  • the pharmaceutical combinations provided by the present invention eliminate this inherent, adverse dichotomy between therapeutic efficacy and tolerability by potentiating the therapeutic effect of prescribed opioids, which is clinically translated to a more beneficial therapeutic result or to the use of lower dosages of opioids to obtain a predetermined therapeutic result.
  • the pharmaceutical combinations provided by the present invention further advantageously eliminate or substantially minimize adverse side-effects commonly associated with opioid uptake in opioid-prescribed patients.
  • the therapeutic window of the opioids is expended by the pharmaceutical combinations provided herein such that (a) standard opioid dosages, e.g.
  • the present invention provides, in one aspect, a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof.
  • the molar ratio between the opioid or the salt thereof and the N-acylethanolamine or the salt thereof is between about 1 :1 to about 1 :100, about 1 :1 to about 1 :1000 or about 1 :1 to about 1 :10000.
  • Each possibility represents a separate embodiment of the present invention.
  • the present invention provides, in another aspect, a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid or the salt thereof and the N-acylethanolamine or the salt thereof is between about 1 :1 to about 1 :100.
  • a “pharmaceutical composition” refers to a preparation of the active agents described herein with other chemical components such as physiologically suitable carriers and excipients. The purpose of a pharmaceutical composition is to facilitate administration of a compound to an organism.
  • pharmaceutically acceptable carrier refers to a carrier, an excipient or a diluent that does not cause significant irritation to an organism and does not abrogate the biological activity and properties of the administered compound. An adjuvant is included under these phrases.
  • excipient refers to an inert substance added to a pharmaceutical composition to further facilitate administration of an active ingredient.
  • excipients include calcium carbonate, calcium phosphate, various sugars and types of starch, cellulose derivatives, gelatin, oils such as vegetable oils or fish oils, and polyethylene glycols.
  • carrier refers to a diluent, adjuvant, excipient, or vehicle with which the compound is administered.
  • Such pharmaceutical carriers can be sterile liquids, such as water and oils. Water or aqueous solution saline solutions and aqueous dextrose and glycerol solutions are preferably employed as carriers, particularly for injectable solutions. Suitable pharmaceutical carriers are described in "Remington's Pharmaceutical Sciences” by E. W. Martin, 18th Edition.
  • phrases "pharmaceutically acceptable” as used herein refers to molecular entities and compositions that are physiologically tolerable and do not typically produce an allergic or similar toxicity when administered to an individual.
  • pharmaceutically acceptable may mean approved by a regulatory agency (for example, the U.S. Food and Drug Agency) or listed in a generally recognized pharmacopeia for use in animals (e.g., the U.S. Pharmacopeia).
  • opioid generally refers to a compound that binds to opioid receptors.
  • opioid also encompasses all natural, semi-synthetic and synthetic opioids.
  • opioid include drugs acting on opioid receptors present in the central nervous system and/or peripheral system, as well as those acting on opioid receptors present in the gastrointestinal tract.
  • natural opioids include, but are not limited to, morphine, codeine, thebaine, dihydrocodein, and salvinorin A.
  • semi-synthetic opioids include, but are not limited to, opium alkaloids derivatives such as diacetylmorphine, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, desomorphine, nicomorphine, oxycodone, dipropanoylmorphine, benzylmorphine and ethylmorphine.
  • opium alkaloids derivatives such as diacetylmorphine, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, desomorphine, nicomorphine, oxycodone, dipropanoylmorphine, benzylmorphine and ethylmorphine.
  • Examples of fully synthetic opioids include, but are not limited to, methadone, tramadol, propoxyphene anilidopiperidines (e.g., fentanyl), phenylpiperidines (e.g., pethidine), diphenylpropylamine derivatives (e.g., loperamide), benzomorphan derivatives (e.g., dezocine), oripavine derivatives (e.g., buprenorphine), and morphinan derivatives (e.g., butorphanol). It also includes endogenous opioid peptides, which may be produced naturally in the body as endorphins, dynorphins or enkephalins but which can also be synthesized.
  • endogenous opioid peptides which may be produced naturally in the body as endorphins, dynorphins or enkephalins but which can also be synthesized.
  • N-acylethanolamine generally refers to a type of fatty acid amide, lipid-derived signaling molecules, formed when one of several types of acyl group is linked to the nitrogen atom of ethanolamine. These amides conceptually can be formed from a fatty acid and ethanolamine with the release of a molecule of water, but the known biological synthesis uses a specific phospholipase D to cleave the phospholipid unit from N- acylphosphatidylethanolamines.
  • amine in ethanolamine because it is considered as a free terminal nitrogen in that subunit, while it is termed "amide” when it is considered in association with the adjacent carbonyl group of the acyl subunit. Names for these compounds may be encountered with either "amide” or "amine” in the present application.
  • ethanolamine is used in the generic sense and is meant to include mono-ethanolamine, di-ethanolamine, tri-ethanolamine, and mixtures thereof.
  • derivative means a compound whose core structure is the same as, or closely resembles that of an N-acylethanolamine compound, but which has a chemical or physical modification, such as different or additional side groups.
  • salt refers to any form of an active ingredient in which the active ingredient assumes an ionic form and is coupled to a counter ion (a cation or anion) or is in solution. This also includes complexes of the active ingredient with other molecules and ions, in particular complexes which are complexed by ion interaction.
  • the molar ratio is between about 1 :1 to about 1 :90, about 1 :1 to about 1 :80, about 1 :1 to about 1 :70, about 1 :1 to about 1 :60, about 1 :1 to about 1 :50, about 1 :1 to about 1 :40, about 1 :1 to about 1 :30, about 1 :1 to about 1 :20 or about 1 :1 to about 1 :10.
  • the molar ratio is between about 1 :2 to about 1 :80, about 1 :2 to about 1 :70, about 1 :2 to about 1 :60, about 1 :2 to about 1 :50, about 1 :2 to about 1 :40, about 1 :2 to about 1 :30, about 1 :2 to about 1 :20 or about 1 :2 to about 1 :10.
  • the molar ratio is between about 1 :2 to about 1 :80.
  • the molar ratio is between about 1 :2.5 to about 1 :5.
  • the molar ratio is about 1 :2.5.
  • the molar ratio is about 1 :5.
  • the molar ratio is at least about 1 :2.5.
  • the molar ratio is at least about 1 :5.
  • the pharmaceutical composition described above comprises about 1-100 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises about 5-90 mg, about 10-80 mg, about 20-70 mg, about 30-60 mg or about 40-50 mg opioid or a salt thereof. Each possibility represents a separate embodiment of the present invention.
  • the pharmaceutical composition described above comprises about 1-90 mg, about 1-80 mg, about 1-70 mg, about 1-60 mg, about 1-50 mg, about 1-40 mg, about 1-30 mg, about 1-20 mg or about 1-10 mg opioid or a salt thereof.
  • the pharmaceutical composition described above comprises about 2-100 mg, about 5-100 mg, about 10-100 mg, about 20-100 mg, about 30-100 mg, about 40-100 mg, about 50-100 mg, about 60-100 mg, about 70-100 mg, about 80-100 mg or about 90-100 mg opioid or a salt thereof.
  • Each possibility represents a separate embodiment of the present invention.
  • the pharmaceutical composition described above comprises about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg or about 90 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises at least about 10 mg, at least about 20 mg, at least about 30 mg, at least about 40 mg, at least about 50 mg, at least about 60 mg, at least about 70 mg, at least about 80 mg or at least about 90 mg opioid or a salt thereof.
  • the pharmaceutical composition described above comprises less than about 10 mg, less than about 20 mg, less than about 30 mg, less than about 40 mg, less than about 50 mg, less than about 60 mg, less than about 70 mg, less than about 80 mg or less than about 90 mg opioid or a salt thereof.
  • Each possibility represents a separate embodiment of the present invention.
  • the pharmaceutical composition described above comprises about 20 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises 35 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises about 55 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises about 70 mg opioid or a salt thereof. In certain embodiments, the pharmaceutical composition described above comprises about 90 mg opioid or a salt thereof.
  • the at least one opioid is selected from oxycodone, morphine, codeine, fentanyl, tramadol, hydrocodone, meperidine, hydromorphone, methadone, naloxone, salts thereof and any combination thereof. Each possibility represents a separate embodiment of the invention.
  • the at least one opioid is oxycodone or a salt thereof. In certain embodiments, the at least one opioid is oxycodone. In certain embodiments, the at least one opioid is a salt of oxycodone. In certain embodiments, the at least one opioid consists of oxycodone or a salt thereof. In certain embodiments, the at least one opioid consists of oxycodone. In certain embodiments, the pharmaceutical composition comprises about 200-1800 mg N-acylethanolamine or a salt thereof. In certain embodiments, the pharmaceutical composition comprises about 250-1550 mg, about 300-1200 mg, about 350-950 mg, about 400-700 mg, about 450-600 mg or about 500-550 mg N-acylethanolamine or a salt thereof.
  • the pharmaceutical composition comprises at least about 50 mg, at least about 100 mg, at least about 150 mg, at least about 200 mg, at least about 250 mg, at least about 300 mg, at least about 350 mg, at least about 400, at least about 450 mg, at least about 500 mg, at least about 550 mg, at least about 600 mg, at least about 650 mg, at least about 700 mg, at least about 750 mg, at least about 800 mg, at least about 850 mg, at least about 900 mg, at least about 950 mg, at least about 1000 mg, at least about 1050 mg, at least about 1100 mg, at least about 1150 mg, at least about 1200 mg, at least about 1250 mg, at least about 1300 mg, at least about 1350 mg, at least about 1400 mg, at least about 1450 mg, at least about 1500 mg, at least about 1550 mg, at least about 1600 mg, at least about 1650 mg, at least about 1700 mg, at least about 1750 mg or at least about 1800 mg
  • the pharmaceutical composition comprises about 50 mg, about 100 mg, about 150 mg, about 200 mg, about 250 mg, about 300 mg, about 350 mg, about 400, about 450 mg, about 500 mg, about 550 mg, about 600 mg, about 650 mg, about 700 mg, about 750 mg, about 800 mg, about 850 mg, about 900 mg, about 950 mg, about 1000 mg, about 1050 mg, about 1100 mg, about 1150 mg, about 1200 mg, about 1250 mg, about 1300 mg, about 1350 mg, about 1400 mg, about 1450 mg, about 1500 mg, about 1550 mg, about 1600 mg, about 1650 mg, about 1700 mg, about 1750 mg or about 1800 mg N- acylethanolamine or a salt thereof.
  • the N-acylethanolamine is selected from the group consisting of N-palmitoylethanolamine (PEA), Me-palmitoylethanolamide (Me-PEA), palmitoylcyclohexamide, palmitoylbutylamide, palmitoylisopropylamide, oleoylethanolamine (OEA), palmitoylisopropylamide (PIA), salts thereof and any combination thereof.
  • PDA N-palmitoylethanolamine
  • Me-PEA Me-palmitoylethanolamide
  • OEA palmitoylisopropylamide
  • PIA palmitoylisopropylamide
  • the N-acylethanolamine is PEA or a salt thereof.
  • the N-acylethanolamine consists of PEA or a salt thereof.
  • the N-acylethanolamine consists of PEA.
  • the mixture comprises oxycodone or a salt thereof and PEA or a salt thereof. In certain embodiments, the mixture consists of oxycodone or a salt thereof and PEA or a salt thereof. In certain embodiments, the mixture comprises oxycodone and PEA. In certain embodiments, the mixture consists of oxycodone and PEA. In certain embodiments, the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is between about 1 :2.5 to about 1 :5. In certain embodiments, the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is about 1 :2.5.
  • the molar ratio between the oxycodone or the salt thereof and the PEA or the salt thereof is about 1 :5.
  • the mixture comprises about 1-100 mg oxycodone or a salt thereof or about 200-1800 mg PEA or a salt thereof.
  • the mixture comprises about 20 mg, about 35 mg, about 55 mg, about 70 mg or about 90 mg oxycodone or a salt thereof or about 250 mg, about 500 mg, about 750 mg, about 1000 mg or about 1500 mg PEA or a salt thereof.
  • the mixture comprises about 1-100 mg oxycodone or a salt thereof and about 200-1800 mg PEA or a salt thereof.
  • the mixture comprises about 5-90 mg, about 10-80 mg, about 20-70 mg, about 30-60 mg or about 40-50 mg oxycodone or a salt thereof and about 250- 1550 mg, about 300-1200 mg, about 350-950 mg, about 400-700 mg, about 450-600 mg or about 500-550 mg PEA or a salt thereof.
  • the mixture comprises about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg or about 90 mg oxycodone or a salt thereof and at least about 50 mg, at least about 100 mg, at least about 150 mg, at least about 200 mg, at least about 250 mg, at least about 300 mg, at least about 350 mg, at least about 400, at least about 450 mg, at least about 500 mg, at least about 550 mg, at least about 600 mg, at least about 650 mg, at least about 700 mg, at least about 750 mg, at least about 800 mg, at least about 850 mg, at least about 900 mg, at least about 950 mg, at least about 1000 mg, at least about 1050 mg, at least about 1100 mg, at least about 1150 mg, at least about 1200 mg, at least about 1250 mg, at least about 1300 mg, at least about 1350 mg, at least about 1400 mg, at least about 1450 mg, at least about 1500 mg, at least about 1550 mg
  • the mixture comprises about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg or about 90 mg oxycodone or a salt thereof and about 50 mg, about 100 mg, about 150 mg, about 200 mg, about 250 mg, about 300 mg, about 350 mg, about 400, about 450 mg, about 500 mg, about 550 mg, about 600 mg, about 650 mg, about 700 mg, about 750 mg, about 800 mg, about 850 mg, about 900 mg, about 950 mg, about 1000 mg, about 1050 mg, about 1100 mg, about 1150 mg, about 1200 mg, about 1250 mg, about 1300 mg, about 1350 mg, about 1400 mg, about 1450 mg, about 1500 mg, about 1550 mg, about 1600 mg, about 1650 mg, about 1700 mg, about 1750 mg or about 1800 mg PEA or a salt thereof.
  • the mixture comprises about 20 mg, about 35 mg, about 55 mg, about 70 mg or about 90 mg oxycodone or a salt thereof and about 250 mg, about 500 mg, about 750 mg, about 1000 mg or about 1500 mg PEA or a salt thereof.
  • the pharmaceutical composition described above is formulated for systemic administration.
  • the pharmaceutical composition described above is formulated for oral, oral mucosal, nasal, sublingual, topical, transdermal, rectal, parenteral, intravenous, intramuscular, subcutaneous, intrathecal, inhalational or vaginal administration.
  • the pharmaceutical composition described above is formulated for oral, oral mucosal, nasal, or sublingual administration.
  • Each possibility represents a separate embodiment of the invention.
  • compositions of the present invention may be manufactured by processes well known in the art, e.g., by means of conventional mixing, dissolving, granulating, dragee- making, levigating, emulsifying, encapsulating, entrapping, or lyophilizing processes.
  • the pharmaceutical composition can be formulated by combining the active compounds with pharmaceutically acceptable carriers well known in the art.
  • Such carriers enable the pharmaceutical composition to be formulated as tablets, pills, dragees, capsules, liquids, gels, syrups, slurries, suspensions, and the like, for oral ingestion by a patient.
  • Pharmacological preparations for oral use can be made using a solid excipient, optionally grinding the resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries as desired, to obtain tablets or dragee cores.
  • Suitable excipients are, in particular, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, and sodium carbomethylcellulose; and/or physiologically acceptable polymers such as polyvinylpyrrolidone (PVP).
  • disintegrating agents such as cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof, such as sodium alginate, may be added.
  • oral administration refers to any method of administration in which an active agent can be administered by swallowing, chewing, sucking, or drinking an oral dosage form.
  • solid dosage forms include conventional tablets, multi-layer tablets, capsules, caplets, etc., which do not substantially release the drug in the mouth or in the oral cavity.
  • Dragee cores are provided with suitable coatings.
  • suitable coatings For this purpose, concentrated sugar solutions may be used which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixtures.
  • Dyestuffs or pigments may be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
  • compositions that can be used orally include stiff or soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol.
  • the capsules may contain the active ingredients in admixture with filler such as lactose, binders such as starches, lubricants such as talc or magnesium stearate, and, optionally, stabilizers.
  • the active ingredients may be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols.
  • stabilizers may be added. All formulations for oral administration should be in dosages suitable for the chosen route of administration.
  • compositions may take the form of tablets or lozenges formulated in conventional manner or in adhesive carriers.
  • the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., a sterile, pyrogen- free, water-based solution, before use.
  • Pharmaceutical compositions suitable for use in the context of the present invention include compositions wherein the active ingredients are contained in an amount effective to achieve the intended purpose. More specifically, a "therapeutically effective amount" means an amount of active ingredients effective to prevent, alleviate, or ameliorate symptoms or side effects of a disease or disorder, or prolong the survival of the subject being treated. Determination of a therapeutically effective amount is well within the capability of those skilled in the art, especially in light of the detailed disclosure provided herein.
  • a "therapeutically effective amount of a mixture” means an amount of at least two active ingredients, wherein each one of the active ingredients independently may not be in a therapeutically effective amount or wherein both of the active ingredients may not be in a therapeutically effective amount, the mixture is nevertheless effective to prevent, alleviate, or ameliorate symptoms or side effects of a disease or disorder, or prolong the survival of the subject being treated.
  • the term "mixture” as used herein refers to a non-covalent combination of two molecules.
  • the dosage or the therapeutically effective amount can be estimated initially from in-vitro, in-vivo and cell culture assays.
  • a dose can be formulated in animal models to achieve a desired concentration or titer. Such information can be used to more accurately determine useful doses in humans.
  • the dosage of each compound of the claimed combinations depends on several factors, including: the administration method, the disease to be treated, the severity of the disease, whether the disease is to be treated or prevented, and the age, weight, and health of the person to be treated. Additionally, pharmaco -genomic (the effect of genotype on the pharmacokinetic, pharmaco -dynamic or efficacy profile of a therapeutic) information about a particular patient may affect dosage used.
  • Continuous daily dosing may not be required; a therapeutic regimen may require cycles, during which time a drug is not administered, or therapy may be provided on an as-needed basis during periods of acute disease worsening. Dosage escalation may or may not be required; a therapeutic regimen may require reduction in medication dosage.
  • Toxicity and therapeutic efficacy of the active ingredients described herein can be determined by standard pharmaceutical procedures in vitro, in cell cultures or experimental animals. The data obtained from these in-vitro and cell culture assays and animal studies can be used in formulating a range of dosage for use in human. The dosage may vary depending upon the dosage form employed and the route of administration utilized.
  • Dosing can be of a single or a plurality of administrations, with course of treatment lasting from several days to several weeks, or until cure is effected or diminution of the disease state is achieved.
  • the present invention further provides, in another aspect, a dosage unit comprising or consisting of any one of the pharmaceutical compositions described above.
  • the dosage unit comprises the pharmaceutical composition described above.
  • the dosage unit consists of the pharmaceutical composition described above.
  • the dosage unit is formulated as a gel, a powder or a spray.
  • the dosage unit is formulated as a gel.
  • the dosage unit is formulated as a powder.
  • the dosage unit is formulated as a spray.
  • the dosage unit comprises or consists of a daily dose, a daily sub-dose or an appropriate fraction thereof, of the active ingredients. In certain embodiments, the dosage unit comprises a daily dose of the active ingredients. In certain embodiments, the dosage unit comprises a daily sub-dose of the active ingredients. In certain embodiments, the dosage unit consists of a daily dose of the active ingredients. In certain embodiments, the dosage unit consists of a daily sub-dose of the active ingredients. Unless otherwise indicated, the term "active ingredients" refers to opioids and N-acylethanolamines.
  • the present invention further provides, in another aspect, a pharmaceutical composition or a dosage unit as described above, for use in a method for preventing or treating a condition amenable to prevention or treatment by at least one opioid.
  • a condition amenable to prevention or treatment by at least one opioid generally relates to any adverse health condition, disease or disorder, such as pain, depression, respiratory difficulties, coughs and diarrhea, which is prevented or ameliorated or which at least one of its symptoms is prevented or ameliorated, by treatment with at least one opioid.
  • the condition amenable to prevention or treatment by at least one opioid is selected from the group consisting of pain, depression, respiratory difficulties, shortness of breath, coughs, irritable bowel syndrome and diarrhea.
  • treating includes, but is not limited to, any one or more of the following: abrogating, ameliorating, inhibiting, attenuating, blocking, suppressing, reducing, delaying, halting, alleviating or preventing one or more symptoms or side effects of the diseases or conditions of the invention.
  • acute refers to a condition with a relatively short, severe course.
  • chronic as used herein means that the length of time of the diseases or conditions of the invention can be weeks, months, or possibly years. The intensity of the diseases or conditions can differentiate according to various conditions such as patient age, temperature, season, type of disease, etc.
  • Neuropathic pain is a localized sensation of unpleasant discomfort caused by damage or disease that affects the somatosensory system.
  • IASP International Association for the Study of Pain
  • Pain means an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
  • Neuropathic pain may be associated with abnormal sensations called dysesthesia, and pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components. The latter resemble stabbings or electric shocks.
  • neuropathic pain is found in spinal cord injury, multiple sclerosis, and some strokes. Aside from diabetes and other metabolic conditions, the common causes of painful peripheral neuropathies are herpes zoster infection, HIV-related neuropathies, nutritional deficiencies, toxins, remote manifestations of malignancies, immune mediated disorders and physical trauma to a nerve trunk. Neuropathic pain is common in cancer as a direct result of cancer on peripheral nerves (e.g., compression by a tumor), or as a side effect of chemotherapy (chemotherapy-induced peripheral neuropathy), radiation injury or surgery.
  • the pharmaceutical composition described above is for use in a method for preventing or treating pain.
  • the pain is an acute pain, chronic pain or neuropathic pain.
  • the pain is an acute pain.
  • the pain is chronic pain.
  • the pain is neuropathic pain.
  • the present invention further provides, in another aspect, a pharmaceutical composition or a dosage unit as described above, for use in a method for preventing or treating at least one side-effect associated with intake of an opioid.
  • intake in the present invention is used in its broadest sense, and generally means the administration, use, consumption or ingestion of a substance, for example an opioid, to or by a subject, by any route.
  • the term “intake” is used to describe administration of opioids to human subjects, for example by oral administration, by transdermal administration, or by injection.
  • the term “intake” in the present invention further encompasses the substances, or quantities thereof, taken in and used by the body; this refers to all routes by which opioids enter the body, including by mouth and parenteral administration.
  • the at least one side-effect associated with intake of an opioid is selected from the group consisting of constipation, nausea, sedation, dizziness, drowsiness, confusion, itching, vomiting, tolerance, respiratory depression or suppression, physical dependence, addiction, hyperalgesia, immunologic dysfunction, hormonal dysfunction or imbalance, hallucinations, hypothermia, bradycardia, tachycardia, muscle rigidity and myoclonus.
  • constipation nausea, sedation, dizziness, drowsiness, confusion, itching, vomiting, tolerance, respiratory depression or suppression, physical dependence, addiction, hyperalgesia, immunologic dysfunction, hormonal dysfunction or imbalance, hallucinations, hypothermia, bradycardia, tachycardia, muscle rigidity and myoclonus.
  • the side-effect is irritation. In certain embodiments, the side- effect is confusion, uncontrolled movement and/or disorientation. Each possibility represents a separate embodiment of the invention. In certain embodiments, the side-effect is confusion.
  • condition is amenable to prevention or treatment by oxycodone or a salt thereof, or wherein the side-effect is associated with intake of oxycodone or a salt thereof.
  • the therapeutic potency of the pharmaceutical composition is increased compared to the therapeutic potency of the same pharmaceutical composition without the N-acylethanolamine.
  • the required therapeutic dosage of the opioid in the pharmaceutical composition is decreased compared to the required therapeutic dosage of the opioid of the same pharmaceutical composition without the N- acylethanolamine.
  • at least one of the side-effects of intake of at least one opioid is ameliorated compared to the same side-effect of intake of the same opioid of the same pharmaceutical composition without the N-acylethanolamine.
  • the therapeutic window of the opioid is expended compared to the therapeutic window of the opioid of the same pharmaceutical composition without the N-acylethanolamine.
  • the therapeutic effect of the pharmaceutical composition decreases slower than the therapeutic effect of the same pharmaceutical composition without the N- acylethanolamine.
  • the therapeutic potency of the pharmaceutical composition is increased compared to the same pharmaceutical composition without the N- acylethanolamine.
  • the required therapeutic dosage of the opioid in the pharmaceutical composition is decreased compared to the required therapeutic dosage of the opioid in a similar pharmaceutical composition without the N-acylethanolamine.
  • at least one of the side-effects of the opioid in the pharmaceutical composition is reduced by the use of the pharmaceutical composition compared to the same side-effect while using a similar pharmaceutical composition without the N- acylethanolamine.
  • the therapeutic window of the opioid in the pharmaceutical composition is expended compared to the therapeutic window of the opioid in a similar pharmaceutical composition without the N-acylethanolamine.
  • the N-acylethanolamine increases the therapeutic potency of the opioid compared to the same pharmaceutical composition without the N- acylethanolamine. In certain embodiments, the N-acylethanolamine decreases the required therapeutic dosage of the opioid compared to the same pharmaceutical composition without the N-acylethanolamine. In certain embodiments, the N-acylethanolamine reduces at least one of the side-effects of the opioid compared to the same pharmaceutical composition without the N-acylethanolamine. In certain embodiments, the N-acylethanolamine expends the therapeutic window of the opioid compared to the same pharmaceutical composition without the N-acylethanolamine.
  • the PEA or salt thereof increases the therapeutic potency of the oxycodone or salt thereof compared to the same pharmaceutical composition without the PEA or salt thereof. In certain embodiments, the PEA or salt thereof decreases the required therapeutic dosage of the oxycodone or salt thereof compared to the same pharmaceutical composition without the PEA or salt thereof. In certain embodiments, the PEA or salt thereof reduces at least one of the side-effects of the oxycodone or salt thereof compared to the same pharmaceutical composition without the PEA or salt thereof. In certain embodiments, the PEA or salt thereof expends the therapeutic window of the oxycodone or salt thereof compared to the same pharmaceutical composition without the PEA or salt thereof.
  • N-acylethanolamine increases the therapeutic potency of the opioid refers to the significantly improved therapeutic effect of the opioid when administered with an N-acylethanolamine, compared to the therapeutic effect of the opioid when administered without the N-acylethanolamine.
  • N-acylethanolamine decreases the required therapeutic dosage of the opioid refers to the significantly lower dosage required to achieve a certain therapeutic effect of the opioid when administered with an N-acylethanolamine, compared to the N-acylethanolamine dosage required to achieve the same therapeutic effect when the opioid is administered without the N-acylethanolamine.
  • N-acylethanolamine reduces at least one of the side effects of the opioid refers to the significantly lower severity of at least one of the side effects of the opioid when the opioid is administered with an N-acylethanolamine, compared to the severity of the same side effect when the opioid is administered without the N-acylethanolamine.
  • N-acylethanolamine prolongs the therapeutic window of the opioid refers to the significantly longer period in which the opioid has a therapeutic effect when administered with an N-acylethanolamine, compared to the period in which the opioid has a therapeutic effect when administered without the N-acylethanolamine.
  • the present invention further provides, in another aspect, a method for preventing or treating a condition amenable to prevention or treatment by at least one opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, thereby preventing or treating the condition.
  • the present invention further provides, in another aspect, a method for preventing or treating a condition amenable to prevention or treatment by at least one opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid and the N-acylethanolamine is between about 1 :1 to about 1 : 100, thereby preventing or treating the condition.
  • the method described above is for preventing or treating pain in a human subject in need thereof.
  • the present invention further provides, in another aspect, a method for preventing or treating at least one side-effect associated with intake of opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, thereby preventing or treating the at least one side-effect.
  • the present invention further provides, in another aspect, a method for preventing or treating at least one side-effect associated with intake of opioid in a human subject in need thereof, the method comprising the step of administering to the subject a pharmaceutical composition comprising a therapeutically-effective amount of a mixture of at least one opioid or a salt thereof and at least one N-acylethanolamine or a salt thereof, wherein the molar ratio between the opioid and the N-acylethanolamine is between about 1 :1 to about 1 :100, thereby preventing or treating the at least one side-effect.
  • the administration of the opioid and the N-acylethanolamine is repeated. In certain embodiments of the methods described above, the administration of the opioid and the N-acylethanolamine is repeated three times a day. In certain embodiments of the methods described above, the administration of the opioid and the N-acylethanolamine is repeated twice a day. In certain embodiments of the methods described above, the administration of the opioid and the N-acylethanolamine is repeated once a day. In certain embodiments of the methods described above, the administration of the opioid and the N-acylethanolamine is repeated once every two days. In certain embodiments of the methods described above, the administration of the opioid and the N-acylethanolamine is repeated once every three days.
  • the term "about” as used herein in relation to a value, a plurality of values or a range of values defined by a lowest and highest values means a value which is 10% lower and/or higher than the corresponding value, plurality of values or range of values.
  • the phrase “about 1” means “0.9 to 1.1”
  • the phrase “about 1 or 2” means “0.9 to 1.1 or 1.8 to 2.2”
  • the phrase “about 1 to about 2” means "0.9 to 2.2”.
  • Oxycodone formulation for 10 and 5 mg/kg dose levels - Oxycodone was prepared at a 1 mg/ml concentration by dissolving 10 mg Oxycodone in 10 ml of ethanol:cremophor:saline mixture at a 1 :1 :18 ratio.
  • To prepare 0.5 mg/ml Oxycodone 5 ml from the previous mixture was diluted with 5 ml of ethanohcremophor: saline mixture at a 1 :1 :18 ratio.
  • the formulations were prepared twice, once for the open field test and again for the tail pinch test.
  • PEA formulation for 25 mg/kg dose level - PEA was prepared at a 5 mg/ml concentration by dissolving 30 mg PEA in 6 ml of ethanol:cremophor:saline mixture at a 1 :1 :18 ratio.
  • To prepare 2.5 mg/ml PEA 4 ml from the previous mixture were diluted with 4 ml of ethanol:cremophor:saline mixture at a 1 :1 :18 ratio.
  • the formulations were prepared twice, once for the open field test and again for the tail pinch test.
  • the average animal body weight at study initiation was in the range of 31.97 ⁇ 1.61 g.
  • the minimum and maximum weight in each group did not exceed ⁇ 20 % of group mean weight.
  • Animals were randomly allocated to individual cages on the day of reception. Animals were acclimated for seven to nine days.
  • Test item was administered IP at a dose volume of 10 ml/kg according to the doses in Table 1. Dosing was performed 15 minutes before each of the behavioral tests. Table 2 -Murine dosages
  • the M.W of oxycodone is 315.364 g/mol, and the M.W of PEA is 299.50 g/mol.
  • Open Field (OF) tests were performed as follows - Fifteen minutes after test item/vehicle administration, mice were placed at the center of an open field box (43x43x40 cm) between 9 AM and 5 PM. On each side of the open field box, two frames placed at 2 and 5 cm height with 16 photocell beams per side ensure movement detection. The computer defined grid lines that divided the open field into two compartments: margin and center. Several variables were recorded during a 15 minute session of spontaneous activity including: time spent moving, traveled distance, time spent and number of visits to the central compartment. Tail pinch tests were performed as follows, according to the modified Haffner's method (as depicted in Takagi et al., Jpn. J.
  • mice were pretested by pinching their tail base with an artery clip (1.5 mm width, constant force), and only the mice that show a nociceptive response such as biting the clip or vocalizing within 2 sec were used for experiments. When the mice did not show the above-mentioned behaviors up to 6 sec after pinching, the antinociceptive effect was regarded as positive. To prevent tissue damage, the pressure stimuli was not applied for more than 10 sec. After drug treatments, the nociceptive response in the tail-pinch test was measured at varying intervals.
  • Example 1 Distance travelled. Total distance traveled, associated with the irritation level of a subject, was evaluated during a 15 minute session in the open field test. As illustrated in Figure 1, oxycodone significantly increased the total distance traveled in a dose -dependent manner (see 6M, 8M compared to 1M). Total distance traveled was found to be significantly higher in oxycodone 10 mg/kg (6M, P ⁇ 0.001) and oxycodone lOmg/kg combined with PEA 25 mg/kg (8M, P ⁇ 0.05) compared to vehicle control group (1M) as displayed in Figure 1. PEA (25 mg/kg) in combination with low (5 mg/kg) or high (10 mg/kg) dose oxycodone showed a significant decrease in total distance travelled (see 9M, 7M, respectively).
  • PEA effect of PEA is most notable when comparing groups 6M and 8M, and in comparing group 7M to group 1M and group 9M.
  • the ability of PEA to significantly lower or prevent the oxycodone -related increase in total distance traveled is equivalent to preventing or minimizing adverse side- effects commonly associated with opioid uptake in humans, such as irritation (Crane JH et al., Int. J. Clin. Pharm., 2011 , Vol. 33(5), pages 733-736; Tanaka R et al, Am. J. Hosp. Palliat. Care, 2016).
  • oxycodone significantly increased the velocity of the animals in a dose-dependent manner (see 6M, 8M compared to 1M). The velocity was found to be significantly higher in oxycodone 10 mg/kg (6M, P ⁇ 0.001) and oxycodone 10 mg/kg combined with PEA 25 mg/kg (8M, P ⁇ 0.05) compared to vehicle control group (1M) as displayed in Figure 2.
  • PEA 25 mg/kg in combination with low (5 mg/kg) or high (10 mg/kg) dose oxycodone showed a significant decrease in velocity (see 9M, 7M, respectively).
  • the effect of PEA is most notable when comparing groups 6M and 8M, and in comparing group 7M to group 1M and group 9M.
  • the ability of PEA to significantly lower or prevent the oxycodone -related increase in average animal velocity is equivalent to preventing or minimizing adverse side- effects commonly associated with opioid uptake in human, such as confusion and/or disorientation (Metrik J. et al., J. Cogn. Psychother., 2011 , pages 1-18).
  • the tail pinch test was performed 15 minutes after the administration of the indicated test item. Pressure was applied to the base of the tail for no more than 10 seconds.
  • a high dose of oxycodone provided a significant analgesic effect which began 15 minutes after administration and lasted at least 90 minutes (6M, P ⁇ 0.001)
  • a high dose of oxycodone combined with PEA provided a significant and extended analgesic effect which began 15 minutes after administration and lasted at least 180 minutes (8M, P ⁇ 0.001), doubling the effective time of analgesia compared to the same treatment without PEA (6M).
  • 6M the effective time of analgesia compared to the same treatment without PEA
  • a low dose of oxycodone provided a significant analgesic effect which began 15 minutes after administration and lasted at least 90 minutes (7M, P ⁇ 0.01)
  • a low dose of oxycodone combined with PEA provided a more pronounced and significant analgesic effect which began 15 minutes after administration and lasted at least 90 minutes (9M, P ⁇ 0.001).
  • the addition of a PEA to a low dose of oxycodone (9M) extended the analgesic effect, or delayed its diminishing, beyond the 90 minutes mark and towards 180 minutes, in a manner that almost reached statistical significance.
PCT/IL2016/050519 2015-05-21 2016-05-17 Combinations of opioids and n-acylethanolamines WO2016185468A1 (en)

Priority Applications (14)

Application Number Priority Date Filing Date Title
IL305528A IL305528A (en) 2015-05-21 2016-05-17 Combinations of opioids and acylethnoamines
DK16796016.0T DK3297622T3 (da) 2015-05-21 2016-05-17 Kombinationer af oxycodon og n-acylethanolaminpalmitoylethanolamin til reduktion af opioidassocierede bivirkninger
US15/575,655 US20180116982A1 (en) 2015-05-21 2016-05-17 Combinations of opioids and n-acylethanolamines
CN202310348490.3A CN116808038A (zh) 2015-05-21 2016-05-17 阿片类物质和n-酰基乙醇胺的组合
CN201680032663.9A CN107613966A (zh) 2015-05-21 2016-05-17 阿片类物质和n‑酰基乙醇胺的组合
PL16796016.0T PL3297622T3 (pl) 2015-05-21 2016-05-17 Kombinacje oksykodonu i n-acyloetanoloaminy palmitoiloetanoloaminy do zmniejszenia skutków ubocznych związanych z opioidami
AU2016263292A AU2016263292B2 (en) 2015-05-21 2016-05-17 Combinations of opioids and N-acylethanolamines
JP2017559829A JP7244992B2 (ja) 2015-05-21 2016-05-17 オピオイドとｎ－アシルエタノールアミンの組み合わせ
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3443987A1 (en) 2017-08-19 2019-02-20 Frimline Private Limited A pharmaceutical composition for prevention of diet induced obesity
US10973782B2 (en) 2017-09-05 2021-04-13 Frimline Private Limited Pharmaceutical composition for improving or preventing progression of chronic kidney disease

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8487007B2 (en) * 2008-04-28 2013-07-16 Vermont Italia Srl Pharmaceutical formulation containing palmitoyl ethanolamide and stearoyl ethanolamide
US20150031685A1 (en) 2012-03-05 2015-01-29 Dr. Reeddy's Laboratories Ltd. Substituted heterocyclic acetamides as kappa opioid receptor (kor) agonists
US20150072971A1 (en) 2013-05-24 2015-03-12 Alkermes Pharma Ireland Limited Methods for Treating Depressive Symptoms
EP2944309A1 (en) * 2014-05-14 2015-11-18 EPITECH GROUP S.p.A. Use of palmitoylethanolamide in combination with oppioids

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8487007B2 (en) * 2008-04-28 2013-07-16 Vermont Italia Srl Pharmaceutical formulation containing palmitoyl ethanolamide and stearoyl ethanolamide
US20150031685A1 (en) 2012-03-05 2015-01-29 Dr. Reeddy's Laboratories Ltd. Substituted heterocyclic acetamides as kappa opioid receptor (kor) agonists
US20150072971A1 (en) 2013-05-24 2015-03-12 Alkermes Pharma Ireland Limited Methods for Treating Depressive Symptoms
EP2944309A1 (en) * 2014-05-14 2015-11-18 EPITECH GROUP S.p.A. Use of palmitoylethanolamide in combination with oppioids

Non-Patent Citations (16)

* Cited by examiner, † Cited by third party
Title
BENYAMIN ET AL.: "Opioid Special Issue", PAIN PHYSICIAN, vol. 11, 2008, pages S105 - S120
CRANE JH ET AL., INT. J. CLIN. PHARM., vol. 33, no. 5, 2011, pages 733 - 736
DESIO, P.: "Combination of oxycodone and palmitoylethanolamide for low back pain treatment.", RIVISTA SIARED DI ANESTESIA E MEDICINA CRITICA, vol. 1.2, 31 December 2011 (2011-12-31), pages 62 - 71. *
DI CESARE MANNELLI ET AL.: "Delay of morphine tolerance by palmitoylethanolamide.", BIOMED RESEARCH INTERNATIONAL 2015;, vol. 2015, 2015, XP055331120 *
DI PAOLO, 34TH NATIONAL CONGRESS AISD - NEW FRONTIERS IN PAIN MEDICINE, 2011
FINGL, E. ET AL.: "The Pharmacological Basis of Therapeutics", 1975, MACK PUBLISHING CO., pages: 1
J.M.K. HESSELINK, THE OPEN PAIN JOURNAL, vol. 5, 2012, pages 12 - 23
JAN M. KEPPEL HESSELINK. ET AL.: "New Targets in Pain, Non-Neuronal Cells, and the Role of Palmitoylethanolamide", THE OPEN PAIN JOURNAL, vol. 5, 29 February 2012 (2012-02-29), pages 12 - 23., XP055331127 *
LEANDER ET AL., J. PHARMACOL. EXP. THER., vol. 234, no. 2, 1985, pages 463 - 469
LESNIAKLIPKOWSKI, ACTA. NEUROBIOL. EXP., vol. 71, no. 1, 2011, pages 129 - 138
METRIK J. ET AL., J. COGN. PSYCHOTHER., 2011, pages 1 - 18
RIVISTA SIARED DI ANESTESIA E MEDICINA CRITICA, vol. 1, no. 2, 2011, pages 460 - 501
S. BEN-SHABAT ET AL., EUR. J. PHARMACOL., vol. 353, no. 1, 1998, pages 23 - 31
TAKAGI ET AL., JPN. J. PHARMACOL., vol. 16, 1966, pages 287 - 294
TANAKA R ET AL., AM. J. HOSP. PALLIAT. CARE, 2016
WAGNERULRICH-MERZENICH, PHYTOMEDICINE, vol. 16, no. 2-3, 2009, pages 97 - 110

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3443987A1 (en) 2017-08-19 2019-02-20 Frimline Private Limited A pharmaceutical composition for prevention of diet induced obesity
US10702487B2 (en) 2017-08-19 2020-07-07 Frimline Private Limited Pharmaceutical composition for prevention of diet induced obesity
US10973782B2 (en) 2017-09-05 2021-04-13 Frimline Private Limited Pharmaceutical composition for improving or preventing progression of chronic kidney disease

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